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Most Newsworthy New Year’s Birth: ACA is an Infant With Boundless Potential

Most Newsworthy New Year’s Birth: ACA is an Infant With Boundless Potential

Paul Terry

Today’s news, of course, featured the birth of the first baby of the New Year: Amber Chrisha L. Caponpon in Guam . Cheers to the proud parents and here’s to the hope that all the extra hoopla doesn’t add to mom’s sleepless nights. Just as Amber’s arrival (at 12:04:30 a.m.) will forever be a major milestone for the Caponpon family, January 1, 2014 also marks the most monumental day in the history of American health policy. The individual insurance mandate, the sunsetting of underwriting as we know it, and the planned obsolescence of the term “pre-existing conditions” in insurance all presage a fundamentally different era for access to health care. Of the 5.7% of those in the individual market, .6% will not be eligible for financial help if they want to continue buying in the individual market. In exchange, starting today, up to 47 million nonelderly uninsured will be eligible for new and/or more affordable health insurance. The good news is that there is no turning back from this miracle arrival. The bad news is there is no starting over either. The stork delivered it with warts and all.

Watch for symptoms of post-policy depression

As much as producing progeny is exhilarating, parenthood also comes replete with mood swings, irritability, and trouble sleeping. Untold new demands will last for months and, given that withdrawal from family and friends is common for new parents, the stresses of parenting may go unnoticed by those who truly care. Similarly, the basic hygiene needs of the ACA will likely dominate policy debates in the year ahead. Given the taxing gestation period and the painful web portal complications, it will be perfectly understandable if those closest to this birth are too overwhelmed to think of much else than the daily care and feeding of this fussy bundle of potential. I, for one, am watching attentively for just such signs of post partum malaise in the health policy community. It will show up as an inordinate political focus on farming and immigration policy in spite of the fact that the ACA falls far short of solving the nation’s most intractable economic burden: the unhealthy habits and declining health of Americans. I’d propose that the treatment is relatively straightforward: It’s time to open the health reform 2.0 savings account and commence with enthusiastic planning about this new infant’s future — and to get busy creating a new sibling.

It’s time to put health into health care policy

Most American’s probably think Obamacare is an insurance portal that’s still on life support. In fact, the ACA arrived today with a lot of wellness in its personality. That the word wellness shows up 86 times in the bill means that disease prevention is part of this baby’s DNA. Starting today, for example, watch how one molecule (section 4205) affects nutrition labeling at chain food retailers. Playing to basic behavioral economics principle, the ACA asks for “prominent, clear and conspicuous” information about the availability of nutrition information, including the calorie counts on foods by serving size. For proponents of making healthy choices easier choices in an otherwise obeseogenic culture, it’s a lovely dimple of an idea. But it’s not even close to solving the problem of unfettered promotion of, and youth access to, bad-for-you foods.

A more substantial ACA trait can be found in section 2705 which allows employers to build financial incentives into their employee wellness programs. I’ve discussed the opportunities that come with this innovation in a prior blog post that includes additional references to the threats to wellness program success if the rules are misconstrued as an opening for a new form of underwriting. As much as wellness professionals are enthusiastic about the prevention traits of the ACA, this progeny has an ego largely vested in access to care. It was the obvious chromosome to root for.

Now, if we stand any chance of containing health care costs in America, health reform 2.0 must be about substantial investments in disease prevention and chronic disease management. Foremost, the next reforms must be about what should become the dominant gene in health care policy: health.

So next time, when people ask me what policy trait I’m hoping for, I’ll say with conviction, You know, just as long as it’s healthy, I’ll be happy.

Managed Care's Prospects in the Health Reform Era

Princeton’s Uwe Reinhardt, PhD, renowned health care economist, sits down with Managing Editor Frank Diamond to discuss the economic effects of the Affordable Care Act, wellness programs, and the state of health care in the United States in general.